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Home My WebLink AboutTIMBERLUX #3 BLK G LT 11 ua, it r41 Municipality of Anchorage On-Site Water and Wastewater Program• (907) 343-7904 AUG 2 8 Zee 1 f 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171237 PID Number: 018-271-65 Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑■ New ❑ Upgrade Name: DMITRY VAKULICH ABSORPTION FIELD Address ❑ Deep Trench EI Shallow Trench ❑ Bed ❑ Mound 4349 MANYTELL ❑ Other Phone Number of Bedrooms Soil Rating Total �depth from original grade mid 4 3.0 GPD/SF 11 0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 0.5 Ft.0.5 Ft. TIMBERLUX #3 BLK G LT 11 Fill added above original grade Gravel length Township Range Section 3.0 Ft. 40 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. Ft. To, Septic Absorption Lift Station: Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 200 Ft2 1.0 Ft. Well 50'+ *501+ *501+ 50'+ TANK Cl Septic I]S.T.E.P. ❑Holding ❑Other Manufacturer Capacity Surface Water 100'+ 1001+ 1001+ ADVANTEX 1500 Gal. Material Number of compartments Lot Line 1 10'+ 5'+ 10'+ ' NA FIBERGLASS 2.0 LIFT STATION Foundation 101+ 101+ 101+ Manufacturer Capacity Curtain Drain UN UN 1 UN I ADVANTEX 100 Gal. Pump on level at Pump off level at High water alarm at Remarks PRE-SET in. PRE-SET in. PRE-SET in. Pump make and model Electrical Inspections performed by STANDARD MOA PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield MIKE ANDERSON Drainfield 3034 CO/MT 3034 Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 102.8 ft Inspection -0 1-19-18 „d 1-19-18 Location and description dates: 2 3"" 4th GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engir e(s..§Lac{` . OF A/�ki Conditional Approval: Date ;h•\P•••• ��I .•:S tt. .y itt *: 49TH ;:‘T4 m // �. MICHAEL N. ANDERSON :� r •. -9 69 • e r s .• 4/, i` •c .; Approved Pi./61-iCCA. 611714 U" Date 05/ie !kip pRQF c�;;tt��... Inspection Report_9-1-12.doc Permit No. OSP171237 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: TIMBERLUX #3 BLK G LT 11 PID No.: 051-351-22 N -' MARK A i B 1 TC01 23 40 \ / r CO2 20 I 38 MT1 40 52 N MT2 76 1 65 i (l l \ \ \ \ \ \ N \� \ \\ N \ \ BENCH \N \ 1 \Ap \__, N \ \............ / / \1 NN I1 1 \ I , - „ \ dr A1500 GALLON ADVANTEX FILB:RGLASS TANK WI POD 001 ��/ �\ 5' SEPARATION I \ \ T 01C0�r/ ' N - -- \ •2 , \ Ill MT1 1;r_— YH 1 DRWEWAY 1 11 \ /r / I 1 1 \ 1 / I I I I III • 1111 1 `I // 1I /// I \�1 ` \ 4WELL r — i -kms \ / / W W \ IRESERV AREA \>/ i /I W \ / — _ - - - \ _ — / \ / \ / N / IN SEPTIC \ ASBUIL-T — ' — ' �� SCALE 1"=4' COI PCO2 f TDOI mut M1z ��G��1��%/i, 1002 MN IDD .••,(`1r O� �` ,'1 _ 17102 �PUNP BASIN :K�`..................�.0 c nilir E J 71111BIR dAR! MIN .0 PIC �J.••••• .� �.�♦.. FILTER FABRIC AND INSUUTgl1 1 49 TH • • _ X593 m OM % /I�/„ f 0 97.5 / I,500 GALLON W 9/POO %�1-- • ADVANIE7 TANK 9/POD T n • 0 ZflL1001W SAND THEN 1II 0 ' •MICHAEL N. ANDERSON!I,/to -/ 0,746 _221 # C, ' No. E 46 : WATER AT 96.5 MAT 2017 V. ••••�� . z .... VV SEPJICN.T.S.CTION 90 - �,, I ,A\•••. Certified Drilling Log DOC CO dba , ,UL6ILLLi1AN WATER WELLS le- P.O. Box 670269,Chugiak,AK 99567 688-2759 OWNER OF LAND: Dmitry Vakulich Bore Hole Data ADDRESS: 4349 Manytell Ave. Anchorage Depth LEGAL DESCRIPTION Timberlux#3 Block G Lot 11 From To DATE: 1048-17 0 2 Casing Stickup PERMIT NUMBER: 05P171237 DATE OF ISSUE: 9-7-17 TAX IDENTIFICATION NUMBER 01827165000 2 4 Overburden Is well located at approved permit location: MYes�No 4 18 Wet Silty Sand &Gravel Method of Drilling: Nair rotary cable tool 18 31 Water Sand &Gravel Depth of Well: 85' 31 80 Tight Silt Sand &Gravel Casing Type: Steel Wall thickness .250 inches 80 85 Silty Sand & Gravel Diameter: 6 inches, depth 84 feet Liner type Static Water Level: 30 feet Recovery Rate 5 M gpm gph Method of Testing Air Well Intake Opening Type: XI open end open hole ri Screened Start feet Stopped n Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth:from 2 feet,to 42 feet Well Disinfected Upon Completion: Myes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: • — A IAL,signs:. in 1 ►. r Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. Development Services Department Building Safety Division • On-Site Water & Wastewater Program PGE e��t rayC°.� 4700 Elmore Street P.O. Box 196650 Mark Begich Anchorage, AK 99519-6650 SAFETY Mayor www.muni.orq/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: OSP/ 7/Z 3 7 Date of Issue: _ - 7 - / 1-7 Parcel Identification Number: 0/e- 274- 6s Legal Description Block Lot Propertywner Name Address: r t,( V4 utA tG( 1 (43-SC /mai/ V-4"I vA9 A- IX 9 c /6 Pump Installation Date: OS - 30 - -to/ 3 Pump Intake Depth Below Top of Well Casing: 65 feet Pump Manufacturer's Name!1 l S J 1ff G Z S p - of [214, Fr 00 T F S`-4��l7 - 3- 00 Pump Model: Pump Size hp Pitless Adapter Burial Depth: _ feet Pitless Adapter Manufacturer's Name: CO 14A p Pitless Adapter Installer: '"IA V Well Disinfected Upon Comption? ' Yes 0 No Method of Disinfection: IO(' vt-Q Comments: Pump Installer Name: 1)Inn 'k"-1 6 1A-(A I. C 1' Company: &J..A- Mailing Addr ss: 11 70 41 IA° City:itike, '`tr? State: A► ^ Zip: "I 3 ) `c. Attention: The pump installer shall provide a pump installation log to DSD within 30 days of pump installation. 1 I N.) N 00'03'24" W 300.00 30 50.92 3o.al i 5' Drainage Easement . -.4%.\ W — SEPTIC to rn i Z - > • .14)j.- _;:, �i, 0 Ui - — 9 F ff N _ \ .p.15\\ C Cli �> .. mM co 0 ' '�. • \\/ c C-. < / \ O _ Y + U . C AVEi pRI/EWA.Y` t q ;: '" O _ �f • ! r /' o 'T' i6 / o o rn Z rrn C i / ,. 0 fel m / / .. co D / -.3'1117.4:77 ..---7' . — -3 < % •• ' ' rn /� / C ' I / 30 N 90'03'24" W 300.00 BobbyF. Burnett GRAPHIC SCALE: 1 Inch = 40 Feet �� 1�\ Lot 11, Block G � � � �!� OF '' '`.1 .,e_.,\ 2941 Carriage Drive TIMBERLUX SUBDIVISION, ADDN #3 Anchorage, 088554ka 99507 1 Plat # 71-240 20 0 20 40 80 *� • y. %; 4# Date Scale .0, 6/21/2017 1" = 40' I hereby certify that the property described hereon has been surveyed / / by me, or at my direction, and that the improvements situated thereon Grid -I are within the property lines and do not overlap or encroach on the ` R 'BY F. BURNETT Ai SW 3136 AS-BUILT property lying adjacent thereto unless otherwise shown. That noa ra-tea D "4Sor improvements on the property lying adjacent thereto encroach on the 1 C:4 Ao,�-rJ-/o rawn by Field Book prennises in question and that there are no roadways, transmission 'X ssIONN• i BFB ASB2018 lines or other easements on said property except as shown. Ilk Nib,_"10r Municipality ofAncl' orag& urpurtnn,.nr P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 s Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCEIWAIVER REVIEW **** Waiver#: OSV171091 COSA#: Permit#: OSP171237 PID#: 018-271-65 Legal Description: Timberlux #3 Block G Lot 11 Engineer: Mike N. Anderson Applicant: Dmitry Vakulich • Your request for a waiver of the required 4 feet vertical separation from the bottom of the absorption field to groundwater has been approved. The approved separation distance is 3.0 feet. In addition, your request for a waiver to provide Engineered Receiving Soil (ERS) in the absence of 2 feet of native unsaturated accepting soil has been approved. See engineer's letter for waiver request and justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 0/20 1 7 Approved by: f&6eec Name of Reviewer **** VARIANCEIWAIVER REVIEW **** p3 o�s 1flz - MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-271-6 5 Property owner(s) Vo- u Day phone Mailing address Site address Legal description (Sub'd., Block & Lot) TIMBERLUX #3, BLK G, LOT 1 Legal description (Township, Range & Section) Lot Size 61500 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field N Initial Single Family (SF) (w/wo ADU) Septic Tank n Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy I (SF and/or D) Private Well I XI Water Storage n THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: SefazimaiT ee een ctrGANicialot r13%).-61dw0.4-e4E.(.S Distance: 3 it I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) l Permit/Rush Fees: T U Q' 1 Waiver Fees:d ] S �/ Date of Payment: 1-1'4.-11-l 11- Date of Payment: 46'-1 Receipt Number: It J �423'1 Receipt Number: }l tel. 131 Permit No. O S/4)41 ).41 Waiver No. C V ` t1 O cT Permit App_. . 3:1 SLOPE TOPSOIL&SEED DESIGN CRITERIA: } (TH#1) '),iI FIL " ABRIC&INSULATION r 0.0 1 25"0 P • . -ADE 4 BDRM X 150 = 600 GPD 0.5 IIMI•`alr SOILS = 600/3.0 = 200 GPD •"DRAIN ROCK BELOW PIPE 200 GA/5 =40' 1 oRG 2.0 3.5 24"OF MOA FILTER SAND (1) TRENCH I 5.0' I THEN TYP II ON 1R-r3.0N,,,, , 0,f 0' DEEP 0.5' EFFECTIVE I GM 5.0'WIDE 40' LONG 10.0 SEPTIC FIELD SECTION I- 7 n L II a I I 1 0 II ec I o I aI w I I �(� , s I I °'A J L - -L - - -r— PF pERTY LINE \ 1 I I Ire) //I I •\ PROPOSED �. r I 1 \t�WELL 100' /// RADIUS f II 1 I I c, ü , , \1 _ /: 1 •••.‘,..-ii- PROPOSED HOUSE ;1 \ II 1 — a w _ sw _ `• * \, -MANYT,ELL AVE- I -\ i PROPOSED I I N:-----, DRAINAGE FIELD w ,t I a I lI I r' \ti >I I I 1\ I 4 • ICC /1 1 I I IV \t`,_______--' - - - - - _J I_ _ _I L - -\ — — _ _ _ L — 1 , 1_1 \ \ Septic Design Prepared for ,111111 DMITRY VAKULICH .•'��E OF 44iti`44+�� TIMBERLUX #3, BLOCK G, LOT 11 , , . y Anchorage, Alaska 49 P.E. r r Michael N. Anderson, PEDATE: 9/5/2017 ,':.MICHAEL N. ANDER50N;' 4601 NATRONA AVE t; No. CE 9469 DRAWN: DJR ♦ = \. ANCHORAGE,ALASKA 99516 •1••' • ... �: (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=200' /11� ESS\ `444 ....tt�\NA OF -4,_%‘‘, Municipality of Anchorage -p'i'vir N@E•fps ? �= Development Services Department j y~•'• �4 y�t Building Safety Division o�*:49TH J� .*/ � �� On-Site Water and Wastewater Program �f 4700 Elmore Road 12.7A - — P.O. Box 196650 Anchorage,AK 99507 /, www.ci.anchoracie.ak.us \` MICHAEL N. ANDERSON• 4 (907)343-7904 /r� �•• -9469 •.•��j Soils Log - Percolation Test �Iretp V/11/4- ••'c: .:- / _ P r tai p^' fES 1�;OaL- Performed For: NI 1 r p Vr1 Al, .ev le``1 Date Performed: Legal Description: 71 •11 11-Er l.0c Wk, t7, (.v 4- I I Township.Range,Section: Slope Site Plan –Cd.: 1241) ... _..._ . Depth (Feet) 2_____ 3- 4 5- (7) > 6- 7 8- WAS GROUND WATER 9- ENCOUNTERED? y v. S 10----- `_ ev r" IF YES,AT WHAT DEPTH? ii,J Depth to Water After P 11- Monitoring? 3 5. E 12- Date: 5:741/J- I �/ 13- �Y•<- 5 er k e cL ()WOW >v -4-rid r 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- 6� /l As l It ///1 1, s 7/' 16- L,I r I,s I. 17- G !/ /ic-" 18 (0" I' Cie 19- - (P n ),3-// 20- • PERCOLATION RATE '70 'rimi:tes/mcg PERC HOLE DIAMETER TEST RUN BETWEEN Z FT AND 3 FT COMMENTS PERFORMED BY: /t4N A I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: isc/l ti/j' MGmail Robert Burnett<littlebearservices@gmail.com> Electric Service 2 messages Robert Burnett <Iittlebearservices@gmail.com> Thu, Sep 7, 2017 at 9:39 AM To: jack.j.hewitt@usace.army.mil Jack, On the wetland permit application POA 2017-225 I did not show the underground electric service from the northwest corner of the property, and down the west property line to the house. Does this require a re-submittal of the permit. Please respond as soon a possible. Thanks Bob Bobby F. Burnett RLS 2941 Carriage Drive Anchorage, AK 99507 Phone 907-350-5541 Littlebearservices@gmail.com Hewitt, Jack J CIV CPMS (US) <Jack.J.Hewitt@usace.army.mil> Thu, Sep 7, 2017 at 10:13 AM To: Robert Burnett <littlebearservices@gmail.com> • Bob, ive// k led Sc 7+vrc� Neither of those activities would be considered a discharge of fill material, so you are good to go. Jack Hewitt Project Manger South Section Regulatory Division Corps of Engineers [Quoted text hidden] Littlebearservices@gmail.com <mailto:Littlebearservices@gmail.com> .11T-irV%kW'"t I • • .., iiti•• . t: , ,. • 1:- r: 4., ...:.., . '? Viknyte 1 4Vt.;;L' . 1 I lierlioxtio . , ./1111WMFailMatagra; - .0 t •L., i. „.4. fr • 2, . .. 1-..,., ' . • . tA .- - •• 1.,.%w L.'' ILf 4wir I. 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V. 1r '7 ' :I . • • • •^` y* . 0£ 6Zallir 40,-; + . -• 44-. . • • i ' ♦ ' r.�1► • �., Igi 'i'.�.�: tel' _ ill 1 t. 4 . . .. • 'fr: r Illy*. il $ vt. . k . 3k.. .14.4 . •I " ' . 111A • 41/4,,„,,,,. * a11 -, r rt y, 7 - • ' , ► do a /CSU 13' r - a"� 5 � d111��:�UIIL,L ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE ANDbwv;‘17 Ja1id- THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this Day ofjl,.S 4- of 2017. by and between Ad4 ivy Vrtku I. h , herein the "OWNER.- and the Municipality of Anchorage. herein the "MUNICIPALITY... In consideration of the mutual covenants contained herein. the parties to this Maintenance and Repair Agreement agree as follows: I. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as . v.w+ Tr� ),4— ss located at (legal description). 1i1►-be 3 ti Gr I_ I ( 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts. components and pieces of an A W WTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA. and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. .11terations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement. the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the A W WTS. In addition. it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense. to pay for any and all: (I) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make an\ necessary maintenance. repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing. executed by authorized representatives of the parties. with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement. the only authorized representatives of the parties are: a. Owner: b1411417V44<<`CA b. Municipality: Director, Community Development or designated authority . C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of co .etent jurisdiction shall not invalidate the remaining provisions of the n =* ance and Repair Agreement. OWNER: By: I (signature) Date: '2/?( I9- _ V otk J: . (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The fore►oing instrument was acknowledged before me this 31 day of nil 2011 .y l .�. Not.— \\\SPG. KW! 4/0 NOTA Y PUC LIC FOR ALASKA = !NOTARY My Cot nission exiiresTY1Q„. ,c 17 *:..PUBLIC:'* ll/l�V ii-VD 1111111��\\ MUNICIPALITY: �� By: jL efa 7t�e'� (signature) Date: q 5 Q Rebee CaXro ` (print name) Title: MUNICIPALITY OF ANCHORAGE Development Services Department R P P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 418-271-65 1. GENERAL INFORMATION Expiration Date: Noy a a,0 Complete legal description TIM BERLUX #3 BLK G LT 11 Location (site address) 4335 MANYTELL AVE ANCH, AK Current property owner(s) Mailing address Real estate agent DMITRY VAKULICH 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4_ TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless othervrise requested by the engineer. COSA Fee $ 660 CAVI Q Date of Payment 7�3//Lc Receipt Number 0:3/0(41 COSA # 05G201�,q 5 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. 6. DSD/SIGNATURE �f System #1 Approved for 4 System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms Date 7`19-20 ' 49T /• • A NlCNAEL N. ANDERSON • CE 946 sy \X ailsst�� ` bedrooms, with the following stipulations: ��•ti"` Y SOF w 1 r _WATE—"NDr WASTEVVATER o PRO By �� ' � t � �� Original Certificate Dater The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: TIMBERLUX #3 BLK G LT 11 Parcel ID: 018-271-65 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system _ A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 1a1111' Total depth 85 ft Cased to 84 ft ❑� Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/23/20 Static water level at beginning of test 31 ft, Comments B. TANK DATA Age of tank(s) 2 years Tank type/material Measured operating fluid level in septic tank Pre -Set N Standpipes/foundation cleanout per record drawing Date of pumping 'Advantex, fiberglass tank, D. ABSORPTION FIELD DATA Advantex System Which system tested (date installed) 1/19/18 ❑fi ALL standpipes present per record drawing Total measured depth from grade 3.0 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Q Code -required soil cover over field Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes Q No X Coliform bacteria is Negative Nitrate 0.224 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 9 Arsenic less than MRL (ND) Collected by MNA Date of Sample 7�23/20 C. LIFT STATION N Required maintenance completed Age of lift station 2 years Lift station material Comments: see Anch Tank records Adequacy test date 7/30/20 Results LDPass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) UK date of test) Gallons introduced gallons If yes, enter date _ Comments/Deficiencies COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No _ It Neighboring Tank > 100' 0 Yes if No_ ft Absorption Field on Lot > 100' ED Yes if No _ ft Neighboring Absorption Fields > 100' 121 Yes if No _ ft Community Sewer Main > 75' ❑✓ Yes if No _ ft Community Sewer Manhole/Cleanout > 100' 21 Yes if No _ ft Private Sewer/Septic Line > 25' ❑Q Yes if No _ ft Holding Tank > 100' Q Yes if No _ ft Animal Containment > 50' 0 Yes if No _ ft Manure/Animal Excreta Storage > 100' Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No_ ft Surface Water > 100' Property Line > 5' ❑,r Yes if No _ ft Absorption Field > 5' Q Yes if No _ ft Water Main > 10'❑ ft ft ft Yes if No _ ft Water Service Line > 10' (21 Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Q✓ Yes if No,_ ft Yes if No _ ft 0 Yes if No _ ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Property Line > 10' Q✓ Yes ❑ Yes if No _ if No 5_+ ft ft If absorption field is under driveway comment below Wells on Adjacent Lots: Water Main > 10' Water Service Line > 10' Surface Water > 100' Yes 0 Yes Q Yes if No _ if No _ if No _ ft ft ft Private Wells > 100' ❑✓ Yes if No _ ft Community Wells > 200' Yes if NO_ ft F. ENGINEER'S COMMENTS * Advantex tank plus field is over 100' G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review Of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet i g�• cid .41 �'1 !} T I 00 ^• MICHAEL N• ANDER50N• •� / 06/04/2020 16:58 8686770 APLUS 371 576 on ■ ■■ ■ ■■m■■ moons ■ �. n I ■ ■ on now on ■ In ONE 0 No 0 I�IvarfTia7l :e Field Maintenance Report Annual Inspr: ction PAGE 05 ■ ■■■ ■ rr & ■ on ■ ■ ■ ■ ■ ■ AnchorageTank 907-272-3543 Pmporty Oxnarinacking x Discharge Amps > >. Lj operator Audible and visual alai Dmitry Vskulich Dial tone (telemetry oral ) ❑ Yea OND Larry Betts Floats .............. ......... Slip Apprppp Pump.............. ........ CWtaot Phom 4335 Manytell Ave, kirchorage AK 99516 (907) 555-5555 AX shp ID p Cpunly ID M Poo r RN F/UL r able p LAAt Intpxtlpn AX -143647 OSP171237 427705 RTU132249 07/15/2019 Retrieve O&M Info Daily flow Reclrc ratio - Timer settings: Perform Field SampIl ig/Observations NTU (15 x NTUs) P,"33 (6•g) DO (2-6) Odor of Sample Typical V Must ❑ Earthy ❑ Moldy Non -typical Sul ri ❑ Cabbage ❑ Decay Oily film In Pvu [ yes No Foam in tank [- yea No Check Control Panell Rocirc Amps Discharge Amps > >. Lj a� Audible and visual alai is AOK Dial tone (telemetry oral ) ❑ Yea OND Inspect/Clean Pump iystem Inspect Rleedl-Id ........... ........./ Current Ll l( PPeVIOD4 Splice Box .......... ......... Pmvl*us 1I'/7�( ' Float Cords ......... ......... Previous Cunem Floats .............. ......... Pump.............. ........ Siotubee Fitter ....... ......... Biotubc Pump Vault .. ......... Recirculating Splitter`,[ vs. -..... Comments Signature __ Clean Measure Sludge/Scum Sludge Scum 1 at Compartment Current Ll l( PPeVIOD4 Curmnt Pmvl*us 2nd Compartment Current Previous Cunem Previous Inspect/Clean AdvanTax Filter Inspect _ Clean p] fW1f � rn 1u Odor: Normal ❑ Pungent Laterele/Odflcea I Intake Vom � Biomat: Normal ❑ Excessive Pod Bottom Bdtlging/Ponding: one/Minor ❑ Excessive Inspect/Clean Discharge Pump System e Inspect Inspect Clean R�f�/ Riser/Lid Floats I�]'i�_ - Splice Box Pump IZ Float cords Inspect/Service Other System Components Inspect Clean Inspect Clean Disinfection Equipment Dispersal Leterals/Odfice��u Observations Additional Services Rendered ❑ Cleaned textile sheets? ❑ Replaced Uv Items? ❑ Raplaoad/Used other items? Parts Used- w. Warranty, B . Billable (✓ appropriate selection) W B Item Number Description Final/Safety Inspection RSV reinstalled ;Zmanlfold reconnoctod; flush valves closod Summa ryliROCOm mandation ❑ System performing; no further action needec E-1callfor service Date 11 Fax completed form to 1-866-384-7404 r/ r Lida bolted on Corttrol panel mactivated El Tank needs pumping ❑ other MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MATNTENANCE AND REPAIR AGREEMENT,herein the "AGREEMENT" made and entered into as of this YDay of_AUa of 20_20, by and between Juho k_ Kley Rao der herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365.In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: . Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWwTS), described as located at (legal description) LI BlockGTmber wy Sub Adi thisn No.3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically S400 to S600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Q Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amend ment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3